Trial reportJournal of the American Medical Directors Association2013
Impact of a decision aid on surrogate decision-makers' perceptions of feeding options for patients with dementia.
Trial report in Journal of the American Medical Directors Association, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 11 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
26 citing papers in PubMed, 11 syntheses or guidelines pooled it, 75 citations in OpenAlex.
- Decision aids for people facing health treatment or screening decisions.The Cochrane database of systematic reviews · 2024Pooled it
- Shared decision-making interventions for people with mental health conditions.The Cochrane database of systematic reviews · 2022Pooled it
- Pooled it
- Enteral tube feeding for people with severe dementia.The Cochrane database of systematic reviews · 2021Pooled it
- Enhancing shared and surrogate decision making for people living with dementia: A systematic review of the effectiveness of interventions.Health expectations : an international journal of public participation in health care and health policy · 2021Pooled it
- Nutrition and hydration for people living with dementia near the end of life: A qualitative systematic review.Journal of advanced nursing · 2021Pooled it
- Interventions to foster family inclusion in nursing homes for people with dementia: a systematic review.BMC geriatrics · 2020Pooled it
- Perspectives of people with dementia and carers on advance care planning and end-of-life care: A systematic review and thematic synthesis of qualitative studies.Palliative medicine · 2019Pooled it
- Decision aids for people facing health treatment or screening decisions.The Cochrane database of systematic reviews · 2017Pooled it
- Effectiveness of interventions to indirectly support food and drink intake in people with dementia: Eating and Drinking Well IN dementiA (EDWINA) systematic review.BMC geriatrics · 2016Pooled it
- Tools to Promote Shared Decision Making in Serious Illness: A Systematic Review.JAMA internal medicine · 2015Pooled it
- Fact Box decision support tools reduce decisional conflict about antibiotics for pneumonia and artificial hydration in advanced dementia: a randomized controlled trail.Age and ageing · 2019Trial
- Factors Influencing Decision Making for Gastrostomy Tube Placement for People Living with Serious Illness: A Scoping Review.Journal of palliative medicine · 2025Article
- Resources to Support Decision-Making Regarding End-of-Life Nutrition Care in Long-Term Care: A Scoping Review.Nutrients · 2024Article
- Decision Aid Interventions for Family Caregivers of Persons With Advanced Dementia in Decision-Making About Feeding Options: A Scoping Review.Journal of the American Medical Directors Association · 2022Article
- Exploring variables related to medical surrogate decision-making accuracy during the COVID-19 pandemic.Patient education and counseling · 2022Article
- Article
- Shared Decision Making in Cardiac Electrophysiology Procedures and Arrhythmia Management.Circulation. Arrhythmia and electrophysiology · 2021Review
- Development of a decision support intervention for family members of adults who lack capacity to consent to trials.BMC medical informatics and decision making · 2021Article
- Eating Problems in Advanced Dementia: Navigating Difficult Conversations.MedEdPORTAL : the journal of teaching and learning resources · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 1 institution in 1 country.
Funding
Abstract
objectivesIn advanced dementia, feeding problems are nearly universal, and families face difficult decisions about feeding options. Initial interviews for a randomized trial were used to describe surrogates' perceptions of feeding options, and to determine whether a decision aid on feeding options in advanced dementia would improve knowledge, reduce expectation of benefit from tube feeding, and reduce conflict over treatment choices for persons with advanced dementia.
designSemistructured interview with prestudy and poststudy design for surrogates in the intervention group.
settingTwenty-four skilled nursing facilities across North Carolina participating in a cluster randomized trial.
participantsTwo hundred and fifty-five surrogate decision makers for nursing home residents with advanced dementia and feeding problems, in control (n = 129) and intervention (n = 126) groups.
interventionFor intervention surrogates only, an audiovisual-print decision aid provided information on dementia, feeding problems in dementia, advantages and disadvantages of feeding tubes or assisted oral feeding options, and the role of surrogates in making these decisions. MEASUREMENTS: The interview included open-ended items asking surrogates to report advantages and disadvantages of tube feeding and assisted oral feeding. Knowledge of feeding options was measured with 19 true/false items and items measuring expectation of benefit from tube feeding. Surrogates reported which of these two feeding options they preferred for the person with dementia, and how confident they were in this choice; their level of conflict about the choice was measured using the decisional conflict scale.
resultsBefore the decision aid, surrogates described advantages and disadvantages of assisted oral feeding and tube feeding in practical, ethical, and medical terms. After review of the decision aid, intervention surrogates had improved knowledge scores (15.5 vs 16.8; P < .001), decreased expectation of benefits from tube feeding (2.73 vs 2.32; P = .001), and reduced decisional conflict (2.24 vs 1.91; P < .001). Surrogates preferred assisted oral feeding initially and reported more certainty about this choice after the decision aid.
conclusionsA structured decision aid can be used to improve decision making about feeding options in dementia care.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.